Chylothorax in thyroid surgery: A very rare case and systematic review of the literature

Abstract

BackgroundChylothorax is a very rare but major complication in thyroid surgery and should be apparent to clinicians in this field.Case presentationWe report a case with chylothrax after thyroid surgery in our department that drew our attention.MethodsSystematic review of the literature to evaluate the incidence and the contributing factors of chylothorax after thyroid surgery. Database (PubMed) and hand searches to identify patients with thyroid surgery and postoperative chylothorax. Keywords included chylothorax, thyroidectomy, thyroid surgery and complications. Two independent reviewers screened studies against inclusion and exclusion criteria. Patient characteristics, risk factors, symptoms, treatments and etiopathogenesis were investigated.ResultsWe identified 13 articles in the literature describing 19 patients with chylothorax after thyroidectomy and described our own case. Ninety percent of the patients underwent thyroidectomy for thyroid cancer. Sixteen patients (80 %) underwent thyroidectomy with at least a left lateral neck dissection, 2 patients (10 %) underwent thyroidectomy with sternotomy, and in the remaining 2 patients (10 %), thyroidectomy with lateral neck dissection on both sides was performed with partial sternotomy. Our calculated incidence for chylothorax with total thyroidectomy and neck dissection was 1.85 %; for a thoracic approach the calculated incidence was 7.3 %.ConclusionsThere are no reports of chylothorax after thyroidectomy without at least a left lateral neck dissection due to advanced thyroid cancer and/or sternotomy due to the thyroid size. The extension of thyroid surgery seems to be the main risk factor in developing chylothorax either through direct surgical trauma or through increased intraductal pressure after thoracic duct ligation. An early diagnosis of chylothorax may avoid severe metabolic or cardiopulmonary complications.

Complication versus Radicality in Papillary Thyroid Cancer Surgery: How to Keep the Balance?

“…The rate of chyle fistula is dependent on the extent of surgical procedure in the neck. The reported incidence of chylothorax after thyroidectomy with lateral ND ranges from 1.2% to 3.8% [16]. In our study, Chyle fistula had an overall incidence of 2.6%.…”

Bilateral chylothorax following reoperative central neck dissection for metastatic papillary thyroid cancer

“…This uncommon complication has been described only in case reports in patients after a thyroidectomy and a left lateral neck dissection or a sternotomy due to the large thyroid size. A systematic review by Merki et al 5 report the incidence of chylothorax after total thyroidectomy and neck dissection was 1.85% and 7.3% when using a thoracic approach.…”

“…Two possible mechanisms of injury have been proposed 5. One possible mechanism includes direct injury or incomplete ligation of the duct during surgery leading to chyle leakage into the mediastinum.…”

Editorial: postoperative chylothorax—a cause for concern

“…The diagnosis of chylothorax was made by detecting chyle leakage from the surgical neck incision as well as chest x-rays and fluid analysis from pleurocentesis. This complication has not been reported previously in conjunction with a right-sided surgical approach in the neck, but there are several case reports of chylothorax after left-sided neck incisions in association with thyroid surgery or radical neck dissection for cancer [4]. It is also a rare but well-known complication after thoracic surgery such as pneumonectomy, lobectomy, esophageal surgery and even after heart surgery [1,3].…”